Earticle

초록

영어

Hypertension is treated with both lifestyle modification and pharmacotherapy. The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), published in 2003, provides a streamlined management approach to hypertension for the primary care physician. The JNC-7 is the gold standard also in Korea. According to the JNC-7, special therapeutic considerations are recommended for high-risk individuals with compelling indications. The presence of compelling indications in any given patient should be considered when selecting specific pharmacotherapy to treat hypertension. However, in patients with compelling indications, it is unknown that hepatotoxicity is caused by Calcium Channel Blocker (CCB), one of 1st anti-hypertensive drugs. Now, the CCB is the most used 1st anti-hypertensive drug in Korea Therefore, we evaluated the changes in blood liver function parameters (ALT, AST, Total bilirubin, serum albumin for the study group. Methods : We randomly collected and retrospectively analyzed Electronic Medical Record data (n=28,788) of patients, and who took calcium channel blockers( non-dihydropyridines; diltiazem, verapamil, dihydropyridines; amlodipine, barnidipine, benidipine, clinidipine, efonidipine, felodipine, isradipine, lacidipine, lercanidipine, nicardipine, nifedipine, nimodipine), with having liver function tests (LFTs) from July 1st 2009 to June 30th 2010 at the Seoul National University Hospital in Korea. Control groups are two antihypertensive agents: RAS blockade (ARB; candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, ACE-I; cilazapril, enalapril, fosinopril, imidapril, perindopril, ramipril) and, Diuretics (loop; furosemide, torsemide, thiazide; hydrochlorothiazide[HCTZ], indapamide). Patients not having LFT results at these three standard points of time(baseline, during, medication, and after finishing medication) were excluded. The collected data were analyzed by using the SPSS (Version12.0) and Microsoft Excel (Version2007). Results : 711 patients who were treated CCB (297), RAS blockade (232) or Diuretics (182) monotherapy were selected for the study. In selected patients, liver damage degree(changes of each LFTs value) was higher in diuretics group than other groups, followed by RAS blockade and CCB. In diuretics group’s was loop-diuretics group was higher than thiazide-diuretics group. In CCB group, Nondihydropyridine- CCB’s damage degree was higher than Dihydropyrine-CCB’s that. Conclusions : Despite the limitations due to the retrospective study, among patients with abnormal LFTs, the use of CCBs led to a less liver damage than other 1st anti-hypertensive agents. It can be recommended CCBs as one of the initial treatments of hypertension in patients with liver disease.

목차

Abstract
 연구 방법
  대상 및 기간
  분석방법
  간기능검사 평가기준
  통계방법
 연구 결과
  연구대상의 특성
  약물복용 중(Point B) 약물별 간기능 상태
  약물복용 후 평균 간손상 정도(B-A, Mean Damage Degree)
  약물종료 후 평균 간회복 정도(C-B, Mean RecoveryDegree)
 고찰
 사사
 참고문헌

키워드

Hypertension Calcium Channel Blocker RAS blockade ACE-I ARB Diuretics Compelling indication Hepatotoxicity Liver function tests ALT AST Total bilirubin serum Albumin

저자

• 김재윤 [ Jae Yun Kim | 충북대학교 임상약학연구실 ]
• 이옥상 [ Ok Sang Lee | 충북대학교 임상약학연구실 ]
• 정선회 [ Sun Hoi Jung | 충북대학교 임상약학연구실 ]
• 이혜숙 [ Hye-Suk Lee | 서울대학교병원 약제부 ]
• 이창호 [ Chang Ho Lee | 한양대학교 의과대학 ]
• 김상건 [ Sang Geon Kim | 서울대학교 약학대학 ]
• 임성실 [ Sung Cil Lim | 충북대학교 임상약학연구실 ] Corresponding Author

참고문헌

발행기관

간행물